Sunday, April 3, 2016

Save Zevalin!

Karl Schwartz, who heads up, has written a letter to the U.S. Senate. He's hoping to save Zevalin, and he needs your help.

Zevalin is an example of RadioImmunoTherapy (RIT), an effective and underused category of treatments for lymphoma.

RIT uses radiation to kill cancer cells. There are lots of cancers that use radiation, but they are almost always "solid" cancers. These cancers involve tumors that will hold still so a beam of radiation can be aimed at them and kill the cells. That doesn't work with "liquid" cancers like lymphomas -- the cancer cells won't hold still. That's where RIT comes in.

With RIT, a small little bit of radiation is attached to something that seeks out individual lymphoma cells -- soemthing like a monoclonal antibody (like Rituxan) that will find a cell with a CD20 protein on it (like a B cell) and then deliver that little bit of radiation right to the cell. RIT has been around for a while, and it has been very effective for the people who have used it. (A couple of the better known are Betsy de Parry and Jamie Reno, both of whom are Follicular Lymphoma patients who have written about their experiences, and who had successful RIT treatments a long, long time ago.)

RIT works differently from other treatments, and a lot of people think that's an even better reason to keep it around. There's been a lot written in the cancer community lately about combining treatments to attack cancer in different ways, and RIT has been mentioned as a good thing to combine with for that reason.

But RIT isn't used as much as it could be, or should be. Even though it has been a very successful treatment, it's kind of complicated to use (or is thought to be complicated). Most of the time, it has to be administered by a nuclear medicine specialist, with a team of nurses. It has also, in the U.S., had some problems with the way doctors are reimbursed when they use it. These are things that don't have anything to do with its effectiveness, but more with how it can be a complicated process to get the treatment to patients.

All of that was enough for one of the RIT treatments, Bexxar, to be pulled from the market 3 years ago.  And now the other RIT treatment, Zevalin, is in trouble.

As Karl explains in his letter to Senator Shelley Moore Capito, who chairs the Clean Air and Nuclear Safety Committee, the Nuclear Regulatory Commission, which oversees nuclear medicine and radiation treatments for cancer, has changed its rules. It used to be that doctors who wanted to administer Zevalin had to have 80 hours of training. Now, they are required to have 700 hours.

That will certainly be enough to make Zevalin all but impossible to administer, since it will deter lots of oncologists from receiving the training. Most cancer patients get their treatments from "community oncologists" -- the folks we see in their offices. They won't have the time to get all of that training. Zevalin will die.

And that will be a shame. While we are all excited about the possibilities that we are seeing with new immunotherapy pathway treatments, Zevalin is a treatment that is 1) already proven to be effective, 2) targets lymphoma cells so side effects are diminished, and 3) works in a way that is different from almost any other treatment.

Karl's letter can be found here. It urges Senator Capito to look into what the NRC is doing with Zevalin. There is space for you to add your name and any comments you have. Please considering doing it. We really don't want to lose this arrow from our quiver.

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